IMC/FM/EMED Rheum/Endo/Renal Flashcards
Define RA
How does this present on exam
What two syndromes can be seen w/ this Dz
Chronic autoimmune inflammatory dz w/ persistent symmetric polyarthritis
AM stiffness improving throughout the day affecting DIP and PIP
Felty’s: RA+splenomegaly and repeat infection
Caplan: pneumoconiosis and RA
What lab result is most specific for Dx RA
How is RA Tx
What drug can be used for Tx of RA and Ankylosing but w/ ? s/e
Anti-CCP
Methotrexate
Hydroxychloroquine
Sulfasalazine
Leflunomide; diarrhea
What will be seen in lab results of OA
What issue develops from OA in the knee
What are the 3 meds that can cause lupus
Normal ESR/CRP
Bakers Cyst
Procainamide
Isoniazid
Quinidine
SLE is a systemic autoimmune d/o characterized by ? triad
? is the best, initial test for Dx SLE
What f/u test is used for confirmation that is 100% specific
Butterfly rash, spares nasolabial folds
Joint pain
Fever
ANA
dsDNA
AntiSM
? lab result in an SLE work up indicates Pt is at higher risk for thrombosis
What result is associated w/ false positives
Pregnant females with the above result are at risk for miscarriages if they also have ?
Antiphospholipid Ab syndrome
Anticardiolipin Ab
B2 glycoprotien 1 Ab
What two biomarkers in an SLE work up indicate a higher risk for neonatal lupus erythematosus
? result has a high sensitivity for drug induced lups
Anti-Ro and Anti-La
Antihistone Ab
SLE is Dx by four or more of ? mnemonic
RASHNIA-4 Rneal d/o Arthralgia Serositis Heme d/o Neuro d/o Imm derangemetns ANA
4 types of rash: Malar discoid Photosensitivity Mucosal involvement
How is SLE Tx
Define CREST Syndrome
What condition is this syndrome associated w/?
Hydroxychloroquine Acetaminophen NSAIDs Sun protection Methotrex/Cychophos
Calcinosis Raynauds Esophageal dysfunction Sclerodactyly Telangiectasis
Scleroderms
How is Scleroderma Dx
How is it Tx
What medication is reserved for resistant cases
Anti-centromere: limited CREST, better prognosis
Anti-SCL 70: diffuse dz w/ multiple organ involvement
Methotrexate
Mycophenolate
Cychlophosphamide
How is Raynauds in Scleroderma Tx
How is P-HTN Tx in scleroderma
How is the renal invovlement Tx in scleroderma
CCBs and prostacyclin
Ambrisenten
Tadalafil
ACEI: Captopril drug of choice during renal crisis
Ankylosing Spondylitis is also associated w/ ? Dxs
? is the gold standard method to eval and support a Dx
How is this condition Tx
Psoriasis
Anterior uveitis
IBDz
Regurg, aortic
X-ray
PT, NSAIDs
Refractory:
a-TNFs: Etanercept, Infliximab
Joint Sxs: Sulfasalzine, Methotrexate
? is the classic triad of Reiters Syndrome
What type of infections is this MC seen w/
How is it Dx
Conjunctivitis
Urethritis
Oligoarthritis
G/C Campylobacter Salmonella Yersinia Shigella
HLA-B27
Synovial fluid: aseptic w/ negative bacterial cultures
How is Reiter’s Tx
Define Gout
What causes these attacks/flares
NSAIDs
ABX
Methotrexate
Etanercept/Infliximab
Uric acid accumulation in joints/tissue
Purine rich food
What meds can cause/worsen gout attacks
What is the name of the attach in the great toe
Define Pseudogout
Thzd/Loops ACEI Pyrazinamide ASA ARBS men >30 and postmenopause women
Podagra
Ca pyrophosphate crystals accumulate in tissues
What joints does Pseudogout affect most often
What will be seen on x-rays of pseudogout
What uric acid levels helps confirm a Dx of tou
Knees, Wrist
Chondrocalcinosis- linear radiodensities
> 7.5
What does gout look like under microscope
What does psuedogout look like under microscope
Neg birefringent needle crystals
Pos biregringent rhomboids
What is done for acute management of gout
What drug is used for 2nd line Tx
What med is used for no response to any of the above
What drug needs to be avoided
NSAIDs-
Naprosyn, Indomethacin
Colchicine
Prednisone, possible first line in elderly Pts
ASA- inc uric acid levels
When is chronic gout management considered
What is used for management
2 or more acute gout flares/year
Allopurinol- dec production
Probenecid (Uricosuric drug)- inc urine excretion
NSAID/Colchicine x 3mon
How is pseudogout Tx
What is used for prophylaxis
Define Polymyositis
First line: CCS
NSAIDs
Colchicine
Chronic, idiopathic inflammatory dz of muscle causing symmetric, proximal weakness/pain
What would be seen on PE in Pts w/ Polymyositis
What parts of the body are MC affected
How is Polymyositis different from Dermatomyositis and Polymyalgia Rheumatica
Early fatigue
Inability to rise from seated
Shoulders, Hips
Derm: skin changes
PR: lack of joint pain
Polymyositis will have inc muscle enzymes
Define Dermatomyositis
What differentiators may be seen on exam
Autoimmune myopathy w/ symmetric proximal weakness AND cutaneous findings
Gottrons: raised purple, scaling plaques on bone prominences
Shawl/V-sign: pink rash on neck/trunk
Heliotrope rash: purple/red rash around eyes/on lids
What would be seen on muscle biopsy results in Dermatomyositis Pts
What serology result is specific for Dermatomyositis
What marker is specific for interstitial lung fibrosis
Endomysial inflammation
Anti-Mi-2 Ab
Anti-Jo 1 Ab
How is Polymyositis/Dermatomyositis Tx
Fibromyalgia is associated w/ ? three issues
How is it Tx
Suppress w/ CCS
Long term Polymyositis management w/ Methotrexate
RA
Apnea
Hypothyroid
TCAs
Swimming
Pregablain
What part of the body is attacked during Sjogrens
How is it Dx
What test can be done in office for Dx
Exocrine glands
ANA
Anti-SS A (anti-RO) and,
Anti SS B (anti-La)
Schirmers tear test: pos if <5mm lacrimation in 5min
How is Sjogrens Tx
What is the Rule of 50 for GCA
What branches of the carotid artery are affected by GCA
Tears
Pilocarpine- cholinergic
for xerostomia
Cevimeline
Age >50
ESR >50
Steroids >50
Posterior Ciliary
Occipital
Ophthalmic
Temporal
Define Polymylagia Rheumatica
This condition is heavily associated w/ ? other d/o
What do Pts present w/ as c/c
Inflammatory condition causing synovitis, bursitis and tenosynovitis
GCA
Morning stiffness and joint swelling w/ normal strength
How is Polymyalgia Rehumatica managed
Define Polyarteritis Nodosa
Small percentage of Pts will have ? underlying d/o
CCS
Methotrexate
Vasculitis of med/small arteries
Hep B/C
Two abnormal c/c making Polyarteritis Nodosa a possible dx
How is a Dx confirmed
How is this condition Tx and what is used for refractory cases
New foot/wrist drop
Rapid developing HTN
Biopsy- necrotizing arteries
Ateriography- aneurysms in small/med arteries
CCS
Refractory= Cyclophos
+Hep B: plasmapheresis
? is the MCC of hypothyroidism
What will be seen on lab results
How is this form of thyroid d/o Dx
Hashimotos
High TSH, low FT4
Anti-TOP Abs
? type of anemia is commonly seen in hypothyroidism
What other lab result is usually high too
How is this Tx
Normo/Normo
Serum cholesterol
Thyroxine/Synthroid
? is the MCC of hyperthyroidism
What will lab results show
How is this Tx
Graves dz
Low TSH, high T3 and FT4 (graves- only T3 is elevated)
Methimazole- mild cases
PTU- including pregnancy
Define Thyroid Storm
How is hyperthyroidism Dx
How are cardiac Sxs of hyperthyroidism Tx
Hyperthyroidism from uncontrolled/un-Dx hyperthyroidism
Anti-thyrotropin Abs (TSHR-Ab)= Graves
Atenolol
How is Graves Dz Tx
What are 5 etiologies of thyroiditis
Methimazole
PTU
Hashimotos Post-Partum Subacute (Quervains) Drug induced Infection w/ bacteria
? is the MCC of thyroid pain
What is the etiology of this MC
What path does this follow and w/ ? lab result
Subacute thyroiditis (Quervains)
Post infectious/viral
Hyper to hypo-thyroid;
Inc ESR
Two common meds that cause thyroiditis
Infectious thyroiditis are usually d/t ? microbes
Painful thyroiditis usually means ?
Lithium
Amiodarone
Staph/Strep
Trauma
Radiation
Infection
Painful subacute
How is Subacute/Postpartum thyroiditis Tx
? is the MC RF for thyroid Ca
? is the MC type
BBs, ASA
Radiation
Papillary
? is the MC benign thyroid nodule
Thyroid nodules must be bigger than ? size to be palpable
What are the RFs for thyroid Ca
Thyroid adenoma
> 1cm diameter
FamHx
Age >65/<20
Radiation
How are thyroid Ca Dx
What imaging results are suspicious for Ca
How to tell if thyroid nodules are malignant or not
US
>1cm- biopsy
Calcifications Hypoechogenicity Solid Irregular margins Chaotic vasculature More tall than wide
Thyroid uptake:
Ca- cold, no uptake; next step= FNA
Benign- hot, will uptake
How is thryoid Ca Tx
What Tx step is different for ? type of Ca
What does hyperparathyroidism cause
Thyroidectomy w/ chemo
External beam radiation- anaplastic Ca
Inc PTH= Inc Ca;
Ca >12= Sxs
What causes Primary and Secondary Hyperparathyroidism
What saying goes w/ the presentation of hyperparathyroidism
What would be seen in UA results
P: PTH secreting parathyroid adenoma
S: CKDz
Bone pain
Stone, kidney
Groan, ab cramps
Psychic depression, irritability, psychosis
Hyperphosphate
HyperCa
How is hyperparathyroidism Tx
How can the hyperCa be Tx
What is used for Tx if osteroporosis is present
Ectomy
Furosemide
Calcitonin
Bisphosphonates
What are the two MCC of hypoparathyroidism
What two PE findings suggest this Dx
What is seen on EKG
Surgical damage
Autoimmune destruction
Trousseaus: carpal
Inc DTRs
Chvosteks: facial
Prolonged QTc
How is hypoparathyroidism Tx immediately
What is done if tetany is present
What is done for long term management
Vit D, Ca
Secure airway
IV Ca gluconate
Recombinant PTH
? bone Ca is most associated w/ Paget’s Dz
Define Paget’s Dz
? infection can cause this dz
Osterosarcoma (Paget’s Sarcoma)
Bone remodeling d/o leading to less compact/weaker bones
Measles
What parts of the body are MC involved w/ Paget’s Dz
What PE finding can be seen in these areas
What non Ortho issue can PTs have
Skull
Lumbar
Pelvis
Femur
Excessively warm d/t inc vasculature
Deafness
How is Paget’s Dz Dx
How is this condition Tx
Define DMT1
Inc ALP levels
CXR- lytic lesions, thickened cortices
Bisphosphonates
Calcitonin
Autoimmune Abs against B-cells
Define Dawn Phenomenon
Define Somogyi effect
How is each one corrected
Normal glucose until early AM increase d/t insuline sensitivity/nightly surge of regulatory hormones
Nocturnal hypoglycemia followed by hyperglycemia rebound d/t GH surge
D: inc bedtime insulin
S: dec bedtime insulin dose
? type of fluid should be used in the Tx of DKA
What lab results Dx DMT1
How are all DMT1 Tx
NS
Fasting >125
A1c 6.5%/>
Random >200 w/ Sxs
Insulin w/
Basal/pre-meal
A1c rechecks q3mon
When does ASA become part of DMT1 Tx
What vaccinations are needed
Men >50y/o or
Women >60y/o w/ one CVD RF:
Hyper-tension/lipid or albuminuria
Tdap
Annual flu
PCV-13
Pneumococcal
Onset, Peak and Duration of insulin
Novolog/Apidra/Humalog:
10-15m 60-90m 4-5hrs
Regular:
30-60m 2-4hr 5-8hrs
NPH
1-3h 5-8hrs 12-18hrs
Levemir
90min no peak 12-24hrs
Lantus
90min no peak 24hrs
Define Gynecomastia
Define Pseudogynecomastia
What is the MCC in infants/boys
Enlarged breast tissue
Appearance of enlarged breast in obese Pts
Physiologic gynecomastia
